Multi-component fall reduction programs demonstrate efficacy, but few data are available showing how best to adapt current evidence-based fall prevention programs for shortterm, low-cost, community-based delivery to seniors. Piggybacking onto ongoing statewide program delivery in 2010-2011, we will conduct a randomized controlled trial involving the PA Department of Aging's Healthy Steps and Healthy Steps in Motion programs to examine their effect on risk of falls over 12 months. This CER research addresses the first quartile IOM priority for public health research: "Compare the effectiveness of primary prevention methods, such as exercise and balance training, versus clinical treatments in preventing falls in older adults at varying degrees of risk." Specific aims Piggybacking onto ongoing statewide program delivery in 2010-2011, in this Comparative effectiveness research we will conduct a randomized controlled trial in which seniors will be randomly assigned to three conditions: (i) usual care, with delayed entry into the program (n=750), (ii) Healthy Steps for Older Adults (n=750), or (iii) Healthy Steps in Motion (n=750). We will also recruit a targeted sample of Latino seniors (n=300) to explore the effectiveness of the fall prevention programs in this growing older minority population. Key innovations in this intervention include training of lay service providers to conduct mobility assessments and deliver the program, referrals and follow-up to primary care physicians in people identified at risk for falling through physical assessments, and referrals and follow-up for assessment of home hazards that may increase risk of falls. The specific aims of this research are to: 1. Assess reduction in incidence at 6 and 12 months of (i) falls adjusted for activity level and (ii) injurious falls 2. Examine uptake of intervention: Assess change in activity profiles and falls self-efficacy in the study arms 3. Determine if intervention effects are replicated in Latino seniors and other targeted subsets of participants 4. Assess cost effectiveness of Healthy Steps and Healthy Steps in Motion This CER research addresses the first quartile IOM priority for public health research: "Compare the effectiveness of primary prevention methods, such as exercise and balance training, versus clinical treatments in preventing falls in older adults at varying degrees of risk."